Action Collaborative on Clinician Well-being and Resilience Victor J. Dzau July 14, 2017
Breaking the Culture of Silence Paper Series Breaking Silence, Breaking Stigma Jasleen Salwan, Sandeep Kishore
Multitude of Factors Drive Burnout Stigma and fear of vulnerability Regulatory environment Reimbursement environment Digital health environment Organizational leadership Learning environment Culture of silence
Timeline July 2016: 30+ professional organizations gathered to assess the parameters of clinician burnout and explore collaborative engagement Clear need for collective action September 2016: Call with July meeting attendees to formalize creation of an action collaborative January 2017: Launch of the collaborative Identified potential focus areas and activities Developed a framework for action Special address by VADM Vivek K. Murthy, former U.S. Surgeon General
Clinician Wellbeing & Resilience Collaborative Goals Improve baseline understanding across organizations of challenges to clinician wellbeing Learning collaborative: Share lessons & best practices Advance evidence-based, multidisciplinary solutions to reverse these trends, leading to improvements in patient care by caring for the caregiver. Raise visibility of clinician stress and burnout
Leadership Team Victor J. Dzau, President, NAM, chair Darrell G. Kirch, President and CEO, AAMC, co-chair Thomas J. Nasca, CEO, ACGME and ACGME International, co-chair
Make up of the Collaborative 55 participants representing: Professional organizations Government Technology and EHR vendors Large health care centers Payors
Sponsoring Organizations (1) ABFM Foundation Accreditation Council for Continuing Medical Education Accreditation Council for Graduate Medical Education Aetna Alliance of Independent Academic Medical Centers American Academy of Family Physicians American Academy of Neurology American Academy of Pediatrics American Association of Colleges of Nursing American Association of Colleges of Osteopathic Medicine American Association of Critical-Care Nurses
Sponsoring Organizations (2) American Board of Internal Medicine and the ABIM Foundation American Board of Medical Specialties American College of Emergency Physicians American College of Physicians American College of Surgeons American Congress of Obstetricians and Gynecologists American Dental Education Association American Hospital Association American Medical Association American Nurses Association American Osteopathic Association American Psychiatric Association American Society of Anesthesiologists
Sponsoring Organizations (3) American Society of Health-System Pharmacists Association of American Medical Colleges (with support from the Centers for Disease Control and Prevention) Council of Medical Specialty Societies CRICO Federation of State Medical Boards IBM Watson Health Johns Hopkins Medicine Massachusetts General Hospital Society for Academic Emergency Medicine and Association of Academic Chairs of Emergency Medicine Society of Neurological Surgeons UAB Medicine UnitedHealth Group
Additional Expertise Government: Agency for Healthcare Research and Quality Centers for Disease Control and Prevention Centers for Medicare and Medicaid Services Department of Defense Department of Veterans Affairs EHRs/Health IT Epic IBM Watson Health National Patient Safety Foundation Researchers, trainees, and early career professionals
Steering Committee Victor J. Dzau, National Academy of Medicine Darrell G. Kirch, Association of American Medical Colleges Thomas J. Nasca, Accreditation Council for Graduate Medical Education Steven Bird, Society for Academic Emergency Medicine Robert Harbaugh, Society of Neurological Surgeons Art Hengerer, Federation of State Medical Boards Lois Margaret Nora, American Board of Medical Specialties Pamela Cipriano, American Nurses Association Daisy Smith, American College of Physicians Neil Busis, American Academy of Neurology Clifton Knight, American Academy of Family Physicians Sandeep Kishores, Icahn School of Medicine at Mount Sinai
Working Groups Research, Data and Metrics Messaging and Communications Conceptual Model External Factors and Workflow Charged with creating products and activities to effect the factors driving clinician well-being and burnout, and develop organizing principles for the work of the collaborative
Progress in 6 months Formed 4 working groups Developing a network of 55 partner organizations Foundational work Review of evidence base and best practices
Discussion Paper Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care Lotte N. Dyrbye, Tait Shanafelt, Christine A. Sinsky, Pamela F. Cipriano, Jay Bhatt, Alexander Ommaya, Colin P. West, David Meyers
Vision for the Future Evidence based solutions Leveraging networks of organizations committed to improving & implementing clinician well-being Grow the network to create a larger community of empowerment A campaign of system change
Establishing Clinician Well-being as a National Priority Meeting Objectives Provide an overview of the magnitude, drivers, and effects of burnout among health care professionals Present the mission, goals, and progress of the working groups Explore promising approaches to promoting clinician well-being
Action Collaborative Staff Charlee Alexander, Program Officer, NAM (cmalexander@nas.edu) Kimber Bogard, Senior Officer, NAM Kyra Cappelucci, Communications Associate, NAM Laura DeStefano, Associate Director of Communications, NAM Molly Doyle, Communications Specialist, NAM Sharyl Nass, Director, Board on Health Care Services, Health and Medicine Division (HMD) Mariana Zindel, Senior Program Assistant, HMD
Fellows Rajadhar Reddy, Archer Fellow, University of Texas at Dallas (Jan-April, 2017) Jake Thomas, DukeEngage Fellow, Duke University (May-July 2017) Skye Tracey, DukeEngage Fellow, Duke University (May-July 2017)
Sign up for the listserv at nam.edu/clinicianwellbeing
Appendices
July 2016 NAM Convening 30+ professional organizations Focus: Assess the parameters of clinician burnout and explore collaborative engagement Objectives: 1. Improve baseline understanding across organizations of challenges to clinician well-being 2. Consider activities currently underway to address these issues 3. Explore opportunities for collaborative engagement 4. Consider the potential role of the NAM in leading an initiative to address these issues
Action Collaboratives at the NAM Perspectives NAM Discussion Papers (white papers) Commentaries Terrain mapping Data analysis and synthesis Targeted surveys Tools development Implementation tools Digital applications Incubating capacity Organizations Networks
Research, Data and Metrics 1. Standardization of a menu of questions to use across pre-existing survey instruments 2. NAM Perspectives papers: Designing a longitudinal study to assess stress, burnout, and depression The financial cost of replacing health care providers (HCPs) Potential natural experiment compare the wellbeing of HCPs in practices before and after implementing EHRs 3. Identify metrics and measures to track the collaborative s progress in reducing burnout and improving the well-being of HCPs
Messaging and Communications 1. Key audience groups: public/patients; HCPs; and influencers (policymakers, CEOs, payors, regulators, health IT vendors) 2. Messaging principles: Create key messages that are communicated differently based on audience group/stakeholder Take a proactive tone Be positive Share nuances of well-being 3. Knowledge hub An open access repository of information, resources, models, and tools to be used at the individual and organizational level.
Conceptual Model 1. Define a wide range of terms related to HCP well-being, both positive ( joy in medicine ) and negative ( moral distress ) 2. Create an all-encompassing conceptual model that reflects the domains affecting HCP well-being (work env., learning env., personal/professional factors), culture, values, care delivery Unifying model to communicate to outside stakeholders alongside key messages Narrow in on specific areas for action/opps to create systemic change 3. NAM Perspectives paper series with personal stories and possible solutions from collaborative participants
External Factors and Workflow 1. Mapping exercise - ensure we have a comprehensive look at the drivers of stress, burnout, depression 2. Stakeholder analysis to identify groups directly/indirectly involved in promoting well-being 3. 2x2 table identifying individual, systemic, short-term, long term solutions Practical, off the shelf; aspirational, long-term 4. NAM Perspectives papers Health IT (identify pain points for each profession, make recommendations for improvements) Regulatory pressures (modernizing guidelines to fit current env.; deactivating dated protocols) Administrative burdens (alternative payment models)